Clinical Assessment Flashcards
In Clinical formulation and assessment of people there are five dimensions that influence treatment planning, what are they?
- Formulation
- Risk assessment
- Research
- Process issues
- Diagnosis
What is the purpose of the Mental Status Examination (MSE)?
It is to see how all of the dimensions of planning work together to generate a treatment.
What are all of the factors in which the MSE looks for?
- Mood and affect
- Thought
- Perception
- Cognition
When assessing mood and affect, what are cues, mood and affect?
Cues
behaviour, appearance, facial expression and presentation
Mood
Sustained internal feeling, frame, over days/weeks
Affect
Refers to characteristics communicated during the interview - the interpersonal dimensions in the here and now
Range (constricted/labile)
Reactivity (blunted or flat to reactive
Appropriateness
In the MSE how do we assess thoughts?
Content
unusual content (magical thinking)
Overvalued ideas - these are excessively important that dominant over an idea
Delusions (persecutory, grandiose, bizarre)
Form
Rate, responsibility and spontaneity
Coherence - use of standard grammatical forms and sentence structure
Capacity to sustain train of thought (circumstantiality tangentiality, fight of ideas, thought blocking, word salad)
Usually word usage - neologisms
In the MSE how are perceptions assessed?
Sensory distortions and illusions
Hallucinations (hearing, vision, smell, taste and touch)
Other abnormal perceptions
Depersonalisation and derealisation
In the MSE how is cognition assessed?
Orientation to time, place and person (awareness to confused)
Attention and concentration (distraction due to intrusive thoughts, impaired reasoning, impaired concentration)
Memory and weather a good historian
Capacity for abstraction and reasoning (concrete thinking to abstract thinkings, deducing theme)
Current functioning in relation to previous functioning
Tools - MMSE, proverbs, serial 7
In assessing cognitions how are proverbs and serial 7 used?
they asses someones ability to abstractly think
They ask a patient to take away 7 from 100 at least 5 times
In suicide assessment what are some risk factors?
Ideation, plans, intent to act, means
Acute stress (especially interpersonal, recent discharge from acute psychiatric services)
Depression
Impulse control problems
Humiliation/embarrassment
Hopelessness
Use of substances
Previous models of self-harm
What are some protective factors in suicide prevention?
Beliefs (e.g., meaning, sources of fulfilment)
Family (e.g. children)
Social support
Upcoming positive experiences to look forward to
Michael Lambert created the Outcome Questionnaire (OQ45) which assesses how well someones treatment is going - it is designed to measure someones progress through therapy and afterwards. What are the 3 domains of experience it covers?
- Symptom distress (SD) - degree of subjective discomfort
- Interpersonal relations (IR) - impairment in interpersonal functioning
- Social Roles (SR) - impairment in work and other social roles
It can screen for suicide, substance abuse and anger and violence at school and work
What is Scott Millers dimensions on the Session rating scale and why is it used?
Relationships
Goals and topics
Approach or method
Overall
Graph that and have a really accurate sense of how your relationship is going with someone - referrals, standing up in court
What are Major depressive categorised as in the DSM-5?
Five or more of the following symptoms have been present during the same 2-week period and represent change from a previous functioning: at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: do not include symptoms that are clearly attributable to another medical condition:
Depressed mood: Most of the day, nearly everyday, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appear tearful). Note: in children and adolescents, can be irritable mood
Markedly diminished interest or pleasure in all
Or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation)
Significant weight loss when not dieting or weight gain
E.g. a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day (note: in children, consider failure to make expected weight gain)
Insomnia or hypersomnia
Psychomotor agitation or retardation nearly everyday
Fatigue or loss of energy nearly everyday
Feelings of worthlessness or excessive or inappropriate guilt
Diminished ability to think or concentrate
Recurrent thoughts of death
